Supervision is a systematic process for increasing efficiency of the health personnel by developing their knowledge, perfecting their skills, improving their attitudes towards their work and increasing their motivation. It is thus an extension of training.

Supervisory visits by STDCs should not be a fault finding exercise but need to be a collaborative effort to identify problems and find solutions. The effort by the supervisory team, should be issue based and directed at provide ongoing support for solving problems and to overcome difficulties. Feedback provided during the visit should be constructive (with practical solutions) and not mere observations on performance. It should aim to build capacity of the health staff to implement the program procedures correctly with high level of efficiency, to assess HR and training needs and to ensure data and service quality. At the end of the visit the staff should be motivated and encouraged to effect solutions and bring improvements in program performance.

Selection of districts: STDCs should conduct district wise supportive supervisory visits oriented towards the performance of the district as a whole, and in-turn evaluate performance and build the capacity/ competencies of the District TB Officer and other NTEP staff and health functionaries. Selection of the district for supervision should be made based on the routine monitoring done by STDCs. Districts which require support need to be given preferences and shall be visited more frequently. However, selection should be done such that visits should cover all districts in the state at least once in a year.

Supervisory Team: A minimum of two members consisting of at least one medical officer from STDC/ RTPMC should visit the district for supportive supervision. 

Conducting the visit in the district:

Key thrust program operation areas for a supervisory visit should be purposively decided prior to the visit based on ongoing monitoring of the district performance. The institutions and corresponding staff to be visited may be decided based on the same. For example, if the reason for selection of a district is low treatment success rate from private sector, then high load private sector health facilities, current beneficiaries, their linked TU staff, and district PPM coordinator would be visited.

During the supervisory visit, data quality assessment in the selected focus areas should be done to assess correctness, completeness and timeliness. This would include verifying/ comparing data recorded in Ni-kshay (dates, categories, quantities) against the true/ actual value identified based on the context (recall/ records from beneficiary, hospital records etc.)   

Visit Planning:

The Medical Officer (SM&E) of the STDC/ RTPMC should prepare the advance monthly supervisory visit plan along with the focus areas for each district (ATP-Advanced Tour Program). A minimum of two districts should be visited by the STDC supervisory staff every month. For better efficiency, supportive supervisory visits could be clubbed with EQA visits by IRL. The monthly visit plan (ATP) should be submitted to the STDC Director before 25th day of the previous month. The STDC Director in turn should communicate it to STO, the corresponding districts and the linked National Institute before the first official day of the month.

The supervisory visit should be for two days or more working days in each district. Based on the selected thrust area, institutions, staff and beneficiaries to be visited, the Medical Officer (SM&E) of the STDC may consult with the district to chalk out a suitable travel plan in advance. Based on the plan the Medical Officer (SM&E) needs to arrange suitable travel logistics with the approval of the STDC Director.

Output of a Supervisory visit:

At the end of the supervisory visit, feedback should be prepared. The feedback should be specific action oriented along with supporting observations, with timelines. It should be submitted to the relevant authority(District TB officer, CMO, STO etc) who should take the action within seven days of the end of the visit. STDCs should ensure that the each recommendation is an activity/task for the district/state to perform. STDCs should advocate to solve any issues requiring actions at the state level. STDCs should also monitor the actions taken against each feedback and close the feedback once the task is satisfactorily accomplished.